Endovascular management of spinal arteriovenous malformations

Abstract

Spinal arteriovenous malformations (sAVMs) are rare vascular lesions whose natural history remains incompletely defined. Several classification schemes for sAVMs have evolved based on an improved understanding of the anatomic characteristics as well as pathophysiologic behavior of these arteriovenous shunts. Advances in endovascular technology have inspired the adoption of interventional techniques both as stand-alone treatment and as part of a multi-modality management paradigm for sAVMs. Further refinements in liquid embolic agents as well as improved microcatheter navigability will contribute to an ever-expanding role for endovascular intervention in the management of these lesions.

Clinical Features and Outcomes of Spinal Cord Arteriovenous Malformations

“…Treatment options for fistulous types are determined by the size of the vessels. 18 Microsurgery may be preferred if the feeding artery is too small for microcatheter navigation although the ventrally located fistulas are still challenging. Embolization is the first line of treatment in our institution in most other cases.…”

Management of spinal dural arteriovenouse fistula

“…The symptoms are typically progressive and the natural evolution of untreated patients is to sever aggravation over a period of 6 months to 2 years. Spontaneous recovery has not been reported so far as sudden worsening has been more and more common [1,7].…”

“…The posterior spinal arteries arise from either the posterior inferior cerebellar or vertebral arteries (V3 or V4 segments) and as they descend on either side of the dorsolateral cord surface they are reinforced by segmental/radicular branches. It anastomoses with its fellow and with the anterior spinal artery [1,6].…”

“…More recently Rangel-Castilla et al divided these lesions in type A (SAVFs drain into both the epidural venous plexus and perimedullary venous plexus) and type B (SAVFs drain only into Batson's plexus). Type B1 lesions compress the thecal sac due to an enlarged epidural venous plexus and type B2 lesions lack such compression [1,6,7]. Intradural dorsal SAVFs are the most common type of spinal vascular malformation consisting in a direct connection between a dorsal radiculomedullary arterie and a medullary vein at the dural nerve root sleeve ( Figure 3).…”

“…Type B fistulas are progressively high-flow lesions with multiple minor feeders. Type C fistulas are usually large fistula with a markedly enlarged venous drainage [1].…”